708 - Rehabilitation of a Patient with Neurocardiogenic Syncope and Polypharmacy: A Case Study

Case Diagnosis: A 50-year-old female with multiple chronic co-morbidities and polypharmacy presented with recurrent syncopal symptoms after an an elective cerebral artery bypass to treat her Moya Moya Disease.

Case Description: ST, a 50-year-old female on 14 daily oral home medications, treating multiple comorbidities, presented to inpatient rehabilitation after an elective cerebral artery bypass. The bypass treated her Moyamoya Disease. On admission, her function was impaired by multiple syncopal episodes, which she attributed to her previously diagnosed neurocardiogenic syncope. Her home midodrine previously treating her neurocardiogenic syncope was discontinued for bypass integrity. Diligent review of patient’s medications was highly concerning for polypharmacy.

Discussions: As a young adult with fibromyalgia, migraines, depression, and chronic strokes, ST personifies a population with insufficiently treated polypharmacy.

Conclusions: A multidisciplinary approach and vigilant symptom observation were essential to deprescribing her medications, resulting in symptom control and optimized health.